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• MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
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Building Permit Application
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Planning and Development
Building and •/-Regulation Division
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Cost of Construction:$ 6 Utilities:E]SewerE]Septic Building Height,
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Name
Address: 440 ZmkA El
Zip Code; ax: State-H,
011
Fill In fee simple Title Holder on next page(if different
from the Owner listed above) a
tol `.
If value of construction is 00 or more,a RECORDED Notice of Commencement is required.
JUL/11/2016/MON 02:42 PM FAX No. P. 001
,
DESIGNER ENGINEER: ^Not ApplicableMORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement May result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
` lgnature of#mLnerl Lessee/Agent Signa of Co tr ctot"( cense Tiolcrer
STATE OF
FLOI� vel— STATE OF FLO �COUNTYOF a4 LL!°
COUNTV OF
The for oing instru s acknowledge before me The forgoing instru t as acknowledge before me
this day of 20 by this day of 20 by
(Nrson acknowle Ing) (Name a son acknowied ' g)
J� t
fG
(Si atur of Notary u ic-State of Florida} rypeof;ldentifirat
ure Notary Pu lic- tate of Florida)
ersonally Known OR Produced Identification lly Known OR Produced Identification
Type of identification Produced ruced
JR CIUELINS DIR(MANDIS .4`` = JACQUELINE DERANDIS
Commission No. ? t5E M MIGBION PPOS58 8 ommissian No. �$` ommi. F286898
LsXIsiRE July 94.ZP2b `•: EXPIRES July 14,2020
4P1 99th
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS